Early aspirin withdrawal versus dual antiplatelet therapy in high-risk patients after percutaneous coronary intervention: Meta-analysis of randomized trials - PubMed
3 hours ago
- #Aspirin Withdrawal
- #Percutaneous Coronary Intervention
- #Dual Antiplatelet Therapy
- P2Y12-inhibitor monotherapy (like ticagrelor or prasugrel) after early aspirin withdrawal reduces clinically relevant bleeding compared to continued dual antiplatelet therapy (DAPT) in high-risk post-PCI patients.
- No significant increase in myocardial infarction, death, stroke, or stent thrombosis was observed overall with early aspirin withdrawal and transition to P2Y12-inhibitor monotherapy.
- Immediate aspirin noninitiation or in-hospital cessation is associated with an increased risk of myocardial infarction, whereas early discontinuation post-discharge within 3 months is not.
- Bayesian analysis indicates that in high bleeding risk patients, ≤1-month aspirin discontinuation provides a high probability of bleeding benefit, and in high ischemic risk patients, 3-month discontinuation offers a high probability of both bleeding benefit and MI safety.
- The evidence is conclusive for bleeding benefit and suggests futility for expecting an excess in myocardial infarction with early aspirin withdrawal versus continued DAPT.